Lung cancer surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dildar Hussain, MBBS [2]

Overview

Lung cancer surgery involves the surgical excision of the cancerous tissue. It is used mainly in non-small cell lung cancer with the intention of curing the patient.

Surgery

• Surgery is the best treatment option for patients with resectable tumors.
• The feasibility of surgery depends on the stage of lung cancer at the time of diagnosis.
• The surgical procedures for lung cancer include:
  • Wedge resection (removal of part of a lobe)
    • Wedge resection is performed in patients who do not have adequate respiratory reserve.
    • Radioactive iodine brachytherapy at the margins of wedge resection may reduce the recurrence rate to that of lobectomy.
  • Lobectomy (removal of a single lobe of the lung)
    • Lobectomy is the preferred option for patients with adequate respiratory reserve because it reduces the chances of local recurrence.
  • Bi-lobectomy (removal of two lobes)
  • Pneumonectomy (removal of an entire lung)
  • Sleeve resection

Patient Selection

• The overall operative mortality rate even after careful patient selection is about 4.4%.
• The patient selection for lung cancer depends on:
  • The stage
  • Location and cell type
  • Pulmonary reserve
  • Cardiac evaluation

Stage

• In non-small cell lung cancer, the following stages are suitable for surgical resection:
  • Stage IA
  • Stage IB
  • Stage IIA
  • Stage IIB
• Surgical intervention is not recommended for the management of lung cancer patients with the following stages:
  • Stage IIIA
  • Stage IIIB
  • Stage IV

For more information on staging, please visit non-small cell lung cancer staging.

Pulmonary Reserve

• A sufficient preoperative pulmonary reserve must be present to allow adequate lung function after the tissue is removed.
• Pulmonary reserve is measured by spirometry.
• The preoperative physiologic evaluation established by the American College of Chest Physicians for patients with lung cancer for surgical resection include:
  • Spirometry
  • Measurement of FEV1 and carbon monoxide diffusion capacity (DLCO).
    • The minimum forced vital capacity (FVC) for pneumonectomy in men is 2 liters.
    • The minimum forced vital capacity (FVC) for lobectomy is 1.5 liters.
    • In women, the minimum FVC values for pneumonectomy and lobectomy are 1.75 liters and 1.25 liters, respectively.
• Surgery is contraindicated if spirometry reveals poor respiratory reserve which is often due to underlying chronic obstructive pulmonary disease (COPD).

References

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